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The treatment of endocarditis by vancomycin
The Journal of Antimicrobial Chemotherapy
|December 1, 1984
Summary
Vancomycin is effective for treating endocarditis caused by common bacteria like streptococci and staphylococci. Combination therapy may be needed for optimal outcomes, especially in complex cases requiring surgery.
Area of Science:
- Infectious Diseases
- Cardiology
- Pharmacology
Background:
- Vancomycin has been a key antibiotic for endocarditis therapy and prophylaxis since the 1960s.
- It is used when first-line drugs are unsuitable due to antibiotic resistance or patient allergy.
- Endocarditis is categorized into medical, surgical (early/late), and addict-related types.
Purpose of the Study:
- To review vancomycin usage in different endocarditis subtypes.
- To assess the efficacy of vancomycin monotherapy versus combination therapy.
- To evaluate vancomycin's role in endocarditis prophylaxis.
Main Methods:
- Literature survey and personal clinical experience.
- Analysis of endocarditis cases based on medical, surgical, and addict-related classifications.
- Review of bacterial causes and antibiotic susceptibility patterns.
Main Results:
- Staphylococci are common in early surgical and addict-related endocarditis; streptococci in medical/late surgical.
- Vancomycin is bactericidal for Gram-positive cocci (except enterococci).
- Combination therapy (e.g., with gentamicin, rifampicin) may be crucial for staphylococcal endocarditis, and early surgery is emphasized.
Conclusions:
- Vancomycin is a viable alternative for prophylaxis in certain settings, including cardiac surgery.
- Achieving bactericidal levels does not guarantee monotherapy success, highlighting the need for combination therapy and surgical intervention.
- Vancomycin is suitable for prophylaxis in hospitalized patients, especially those with prosthetic valves.